Affordable Care Act lets foster youths stay on Medi-Cal longer

Updated 10:34 pm, Sunday, May 11, 2014

Marilyn Bretherick had been worrying about turning 21 this month because she feared losing the health coverage she had been guaranteed by the state during a decade as a foster care child.

Then a case manager told her about a little-known provision of the Affordable Care Act that will allow her to keep her coverage for five more years.

The provision allows young adults in California coming out of foster care to stay on Medi-Cal, the state's version of Medicaid, until they turn 26. For Bretherick and other former foster care children like her, that means continued health coverage without having to reapply each year and prove eligibility based on income like all other Medi-Cal applicants.

"I turn 21 on Saturday, so I would have had to make all of my appointments this week," Bretherick said last week. The San Jose State University student had been in foster care from age 10 to 18.

Until this year, under California's Medi-Cal program, she could remain covered for health as a former foster care child, but only until age 21. Because she juggles two part-time jobs that don't come with health insurance, she would have had to worry about Medi-Cal eligibility.

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Softer entry to adulthood

The Affordable Care Act provides a softer landing into adulthood for young people who are generally pushed out of the foster care program to fend for themselves without the benefit of strong family support.

The provision is designed to offer former foster care children a similar guarantee of coverage afforded to children who get to stay on their parents' health plan until age 26 under the health law. The Obama administration has claimed that more than 3 million adults ages 19 to 25 have taken advantage of that provision.

"They're entitled to this because they're the state's kids," said Kelly Hardy, senior director of health policy for Children Now in Oakland, a California youth advocacy organization, referring to the foster care youths. "It may not be the same as staying on parents' insurance until age 26, but it's as close as the state could get."

More than 20,000 youths in the U.S. age out of the foster care system each year, with as many as 5,000 of those young people living in California, according to Children Now.

Many people in their early 20s lack jobs that would offer them health insurance, but advocates say the problem is worse for those who were raised in the foster care system. They often grow up with instability and have a tougher time getting through school, keeping a job and managing life's daily challenges.

"When they're leaving state care, they're often not in the same place in their lives as those who are leaving their parents' homes," said Kate Teague, Bay Area regional coordinator with California Youth Connection, an advocacy group for foster youth between the ages of 14 and 24. "They take longer to get through their education because they often have to support themselves."

Medi-Cal expansion

With the federal health law, California opted to expand Medi-Cal to people making up to 138 percent of the federal poverty level, or about $16,000 a year for an individual.

But the new provision in the Affordable Care Act takes that further by allowing anyone who was in foster care until age 18 anywhere in the U.S. to have continuous Medicaid coverage until their 26th birthday, regardless of income.

In California, the services include physical and mental health coverage, as well as dental care.

Maryam Toloui, program manager with San Francisco Independent Living Skills Program, which helps foster youth, said some former foster children have had to have teeth pulled in their early 20s because they didn't have dental care. She said unplanned pregnancies are harder to prevent without health coverage and mental health problems go untreated.

"Since health care doesn't have to be a worry anymore, they can now focus on school and work and social relationships as the building blocks they need to put together to live a successful life," Toloui said.

For Bretherick, that means she won't have to worry about how to pay for her medications or what to do if she gets sick. "When you have so much on your plate, having that one thing of extra support is just really helpful,' she said.

Coverage again

Her relief was shared by other young people who grew up in the system.

When Anthony Tucker's employer dropped his health insurance benefits, the 24-year-old former foster child scrambled to find new coverage. Tucker, a hydraulic machinist in Merced County, made too much to qualify for Medi-Cal but couldn't afford private insurance.

When he learned a few weeks ago he could go back on Medi-Cal, he immediately signed up and has already made a dental appointment.

"It really helps us out a lot," he said. "I've been out of the system four or five years, and I can still receive the benefits of being a foster youth."

Learn more

Children Now, a statewide youth advocacy group, has begun an outreach campaign to bring awareness to a provision of the federal health law that allows former foster youth to be covered under Medicaid, the health program for the poor known as Medi-Cal in California, until age 26. For more information, visit: www.coveredtil26.org.

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